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Tuesday Apr 26, 2016

FPs Are 'Soldiers in Field' Against Outbreaks

I recently was hired as the medical director of our local health department, and my new role started in the midst of one of the worst pertussis outbreaks on record(www.nkyhealth.org) in my state.

The experience has made realize just how important community physicians are in reporting and controlling an infectious disease outbreak. We are the soldiers in the field, not only caring for the patients affected by the disease, but also collecting information and reporting it to state, local and national health agencies.

Family physicians see patients from every age range and socioeconomic background. It's imperative -- especially during a disease outbreak -- that we keep our eyes and ears open, know how to contact our state and local health departments and report what we see. This means that community physicians need to have a low threshold for testing for specific diseases when an active outbreak occurs.

It's also important to know the rules for reporting infectious diseases at the local, state, and national level. The CDC has a list of reportable diseases(wwwn.cdc.gov), and most local health departments will have a list of diseases reportable in your state.

Although the pertussis outbreak is waning locally and flu season is winding down nationally, a new potential threat is looming. Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, recently said local outbreaks of the Zika virus are likely(www.smithsonianmag.com) this summer in the United States.

If you've read any recent news, you've likely seen reports about the Zika virus and its now-confirmed links with microcephaly in infants. You may have been bombarded with questions from patients or email from public health groups about preparing for the Zika outbreak.

Whenever an outbreak hits, physicians and patients alike need good quality information to make good health care decisions. As primary care physicians, we translate and disseminate critical information to our patients. They trust us to keep them safe, but who do we trust to help us build that knowledge base?

Much like what happened with Ebola, or happens with any other highly publicized disease, lots of information -- and misinformation -- about Zika floods the airwaves and the Internet. Fortunately, the AAFP maintains accurate, up-to-date reference materials concerning Zika.

State and local health departments also are an excellent source of information. Most health departments have one or more epidemiologists who track and report on communicable diseases. They work with a team of medical professionals and communications specialists who collect and collate data, and then create resources for better patient education and disease prevention. Most state health departments work closely with local agencies to devote more personnel and resources to the task.

Once those resources have been developed, they are shipped out to patients and community physicians via multiple channels. We must use this information to help our patients sort the facts from the morass of misinformation that flood the public consciousness.

Zika, a flavivirus similar in structure to the viruses that cause dengue and yellow fever, is most often transmitted to humans by the Aedes mosquito. Recent studies have concluded that the virus can also be transmitted from mother to child, through sexual contact, or by blood transfusions.

Symptoms include fever, skin rash, eye irritation and redness, muscle and joint pain, malaise and headache. Obviously, these symptoms can overlap with many other illnesses, so accurate assessment requires not only a visit with a health care professional but also a full accounting of recent travel or other possible exposures. Currently, no vaccine for Zika exists, and there is no treatment to eradicate the disease once contracted. The best we can do for patients is treat the symptoms and control spread to others.

Preventing the spread of infectious disease depends on community physicians being able to detect and report cases early. Conversely, it's the job of the state and local health departments to communicate to community physicians when an active outbreak is in progress. Community physicians can then report cases to improve surveillance. We can all work together to ensure the safety of our individual patients and the public as a whole.

Have you had good experiences with your state or local health department? Any words of wisdom or best practices for timely communication? Sound off in the comments below or contact me on Twitter @DrTolbert(twitter.com).

Gerry Tolbert, M.D., is a board-certified family physician who practices in northern Kentucky. A lifelong technophile, his interests include the intersection of medicine and technology.

Posted at 02:39PM Apr 26, 2016 by Gerry Tolbert, M.D.

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